1. Hawaii: Postcard Mailout Campaign
Hawaii Covering Kids' statewide postcard mailout campaign is underway to inform families about QUEST and QExA for eligible children and youths. It is a strategy to reach parents affected by the downturn who are unfamiliar with public health insurance programs. Postcards will be mailed to approximately 508,000 Hawaii addresses during the one-month outreach activity.
You can view the postcard's two-sided image on our Facebook page.
2. Michigan: From Healthy Kids to Healthy Adults
Jamel Bomer of Redford Township, a Westin Book Cadillac valet, is the father of a 1-year-old on Medicaid. "He can go to any doctor that accepts it," Bomer said of son Ryan. "Without it, we wouldn't be able to provide him health care." Even with publicly funded Medicaid, which many doctors don't take, Bomer and his fiancee are working off a $230 bill for the part of Ryan's birth that wasn't covered on Bomer's wage of $5.15 per hour plus tips. "Our income is tight to the penny." Although Ryan is covered, neither Bomer nor his fiancee, a TV news intern, have health insurance.
While Congress and the president debate over comprehensive health care reform, local and national experts say making sure all children have coverage now will mean they have a better chance of growing into healthy adults who will be less of a burden on the health care system. There are 7.3 million uninsured children in the country, about 151,000 of them in Michigan, and many more children who are underinsured. Their health insurance may not meet all their needs.
Beth Hurley of Canton has relied on public and private health insurance to care for her two sons with serious health problems. The Hurleys have employer-based coverage now, but to lose it would bankrupt her family. "Financially, it would ruin us," said Hurley, whose 7-year-old son has severe asthma and whose 10-year-old son has a skeletal disorder that requires repeated surgeries not completely covered by their current health insurance. She says she believes, like many experts, in universal coverage for all U.S. children, including thousands of uninsured children in Michigan. With it, her children would be covered no matter what her and her husband's job status.
One way experts say universal coverage could happen would be to increase eligibility for public plans such as Medicaid and the Children's Health Insurance Program (CHIP) which cover most basic pediatric care such as routine visits, and most vaccines plus dental, vision and some mental health visits. CHIP is run in Michigan as MIChild, Medicaid as HealthyKids. Another option for covering children would be through more affordable private health insurance. "People should have to have health insurance just like you have to have car insurance," said Hurley. Universal coverage is supported by people such as Thomasina Stoudemire, 50, an Oak Park grandmother of five. "We don't have time to be messing around saying, 'I have to wait till Friday,'" she said of people who have to wait for paychecks to afford their children's health care.
There are more than 2.5 million children in the country and about 151,000 in the state who have no health coverage, according to the Kaiser Family Foundation. While seeking to insure them, another issue is improving coverage for underinsured children--those with policies that don't cover everything they need, such as Hurley's 10-year-old son. That's why the Hurleys had to buy an extra policy for about $50 per month to cover more of the nearly $50,000 in spine surgery he needs every four months. Universal coverage proponents say children are less expensive to insure--about $1,500 a year compared with $5,000 for adults--so a rough estimate of insuring the 151,000 uninsured children in Michigan would be around $226 million per year, versus about $4.6 billion for the 920,000 uninsured Michigan adults. "Children don't get sick very often. You're paying for preventive care and unexplained, but mild illnesses," said Matthew Davis, University of Michigan pediatrician and public policy expert.
In the long run, the benefits are huge, proponents say. Children with access to health care do better in school because they're not missing class because of illness--and stand a better chance of avoiding some chronic illnesses and being healthy adults, said Dr. Stephen Berman, a child health policy expert and University of Colorado School of Medicine pediatrician. But just how to feasibly insure all children is at the heart of the debate. There are several possibilities for making sure the United States' young people--those with no insurance and those with a limited form--are fully covered, said Berman. Most lawmakers say they believe children should be covered, but they don't always agree on whether it should come through increased public programs or more affordable private policies.
There are multiple ways to achieve this. One is to increase the income limit for families to qualify for MIChild. Currently, the income limit for enrollment is between $40,793 and $44,100 per year for a family of four--about double the federal poverty limit. Increasing the limit to between $60,000 and $66,000 for a family of four--or three times the federal poverty limit--would effectively insure most uninsured children, who are not always the poorest children, said Bruce Lesley, president of the Washington, D.C.-based family advocacy group First Focus. Another option would be to resurrect a 2001 bill for a new national children's insurance program called MediKids. Every child would be enrolled at birth, and if private or other public coverage was lost, MediKids automatically would kick in, Berman said. A third option would create one comprehensive national insurance system for children regardless of parental income. It would be like Medicare for people 65 and older but for children up to age 21, costing about $134 billion, said Berman.
Opponents of health care reform say public programs impede the private insurance trade. So the concern is that parents would leave their private insurance programs in favor of a public option, reducing competition. Yet many public insurance plans are mixes of private and public funds. Private insurers, such as Blue Cross Blue Shield of Michigan, administer MIChild and Medicaid with the help of federal and state money. Davis said there are merits to all the options, but the one that likely would work best for parents and policy makers may not work best for doctors. So, while a MediKids-like program would create a good safety net, it might be a challenge to get doctors to participate. [Megha Satyanarayana, Free Press, 10/12/09]
3. National: Child Deaths Linked to Lack of Health Insurance
An estimated 17,000 children in the United States might have died unnecessarily over nearly two decades because they didn't have health insurance, according to a report from researchers at Johns Hopkins Children's Center in Baltimore.
They found that kids who lacked health insurance were 60 percent more likely to die in the hospital than were kids who had health insurance. After adjusting for such differences as race and gender, uninsured kids were still 37.8 percent more likely to die than kids with health insurance.
David C. Chang, co-director of the pediatric surgery outcomes research group at Hopkins and a study co-author, said he could not think of a medical treatment that has such a dramatic impact on health outcomes as health insurance seemingly does. "This is actually something we as a society can choose to do something about," he said. "It's literally with the stroke of somebody's pen, this could be changed." Bruce Lesley, president of First Focus, noted that data from the U.S. Institute of Medicine have shown that people who are uninsured have a higher mortality rate. "You knew that it existed, you knew that there were cases [of child deaths related to lack of insurance], but I think this data is pretty shocking and really points to the need for national health reform," Lesley said.
In one of his first acts after taking office in January, President Barack Obama signed legislation reauthorizing the Children's Health Insurance Program (CHIP). The measure also provided funding for states to add several million more children to the rolls though 2013. "CHIP has really worked and been very important and insures about 7 million kids in the country," Lesley said. Still, he said, roughly 6.5 million children who are eligible for Medicaid or CHIP remain uninsured--for whatever reason. Enrollment barriers are part of the problem, explained Lesley, whose organization endorses legislative proposals to move toward a "default enrollment" system. "The presumption should be the kid's enrolled and let's figure out what program they're in," he said.
The Johns Hopkins team looked at the relationship between insurance status and kids' mortality to better inform the CHIP debate. Using records from two large databases, lead author Dr. Fizan Abdullah, Chang, and colleagues examined more than 23 million hospitalizations of people younger than 18. Over an 18-year period though 2005, 117 million children were hospitalized. Nearly 6 million kids were uninsured at the time of admission. In all, 38,649 children died while hospitalized. Uninsured kids were 1.6 times more likely to die than children who had insurance.
Assuming that the insured and uninsured populations are identical, the difference in risk of mortality was 60 percent. The authors' actual predicted mortality is lower, however, because factors such as age, race and gender are associated with risks that affect outcomes, Chang explained. "The 60 percent is the theoretical difference, and the 37 percent is the actual difference that you see in real life," he said. "Our extrapolation is based on that more conservative number." The study includes some data from the period before CHIP was enacted in 1997. Though fewer kids are uninsured today than two decades ago, Chang said, that would not skew the risk of death from lack of insurance.
And though the study does not prove that being uninsured boosts a child's mortality risk, it does suggest a strong association between insurance status and odds of dying. "I think the message is health insurance is a choice we can make as a society and this is something that we should consider," Chang said. [Karen Pallarito, U.S. News & World Report 10/29/09]
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